NURS 231 Pathophysiology Final Exam 2026/2027 – Portage
Learning Complete Final Examination | Actual Questions &
Verified Answers | Comprehensive Pathophysiology
Assessment | Pass Guarantee
1. A 68-year-old man with a 40-pack-year smoking history presents with progressive
dyspnea on exertion and a barrel chest. Arterial blood gas on room air shows pH
7.35, PaCO₂ 65 mmHg, HCO₃⁻ 38 mEq/L, PaO₂ 52 mmHg. Which cellular
adaptation most directly accounts for the morphologic change in his lungs?
A. Dysplasia of bronchial epithelium
B. Hyperplasia of type II pneumocytes
C. Hypertrophy of bronchial smooth muscle
D. Atrophy of alveolar septa
Correct Answer: D
Rationale: Chronic alveolar septal destruction (emphysema) removes elastic recoil,
causing terminal airway collapse on expiration and air trapping. The loss of septa
produces “barrel chest” morphology. Atrophy—not hyperplasia—of septa is the dominant
cellular change.
2. A patient with severe Crohn disease develops a deep vein thrombosis. Which
circulating mediator released from inflamed bowel mucosa most directly shifts
the hemostatic balance toward thrombosis?
A. Interleukin-6 inducing hepatic thrombopoietin
B. Tissue factor–bearing microparticles entering portal circulation
C. C-reactive protein inhibiting antithrombin III
D. Nitric oxide scavenging by superoxide
Correct Answer: B
,Rationale: Active IBD lesions shed TF⁺ microparticles that activate factor VII, initiating
systemic coagulation. IL-6 and CRP are pro-inflammatory but do not directly trigger
coagulation cascade.
3. After 3 days of persistent vomiting from pyloric stenosis, a 5-week-old infant is
admitted with serum Na⁺ 128 mEq/L, K⁺ 2.9 mEq/L, Cl⁻ 88 mEq/L, pH 7.50. Which
acid–base disorder is present?
A. Metabolic acidosis with respiratory compensation
B. Metabolic alkalosis with paradoxical aciduria
C. Respiratory alkalosis with renal compensation
D. Metabolic alkalosis with appropriate respiratory acidosis
Correct Answer: B
Rationale: Loss of gastric HCl produces metabolic alkalosis; hypochloremia and
hypokalemia stimulate distal H⁺ secretion (aciduria) despite systemic alkalosis—classic
“paradoxical aciduria.”
4. A 28-year-old woman with sickle cell trait experiences sudden dyspnea while
climbing at 4,500 m. Which pathophysiologic event in the pulmonary
microvasculature is most likely?
A. Intravascular sickling triggered by hypoxia-induced rightward shift of the O₂
dissociation curve
B. Vaso-occlusion by rigid red cells in the relatively hypoxic renal medulla with
secondary platelet activation
C. Localized sickling in subsegmental vessels because of low alveolar PO₂ and
slow capillary transit
D. Endothelial activation by high-altitude cytokine storm
Correct Answer: C
Rationale: Even trait RBCs sickle when PO₂ falls below ~40 mmHg; lung zones at
altitude achieve this, causing micro-occlusion and acute chest syndrome.
5. A patient with diabetic ketoacidosis receives an insulin bolus. Thirty minutes
later the ECG shows peaked T waves and widened QRS. Which plasma shift best
explains the cardiotoxicity?
, A. Intracellular K⁺ influx driven by insulin
B. Extracellular K⁺ shift into cells lowering plasma K⁺
C. Rapid decline in plasma osmolality causing cerebral edema
D. Phosphate entry into cells lowering plasma Ca²⁺
Correct Answer: B
Rationale: Insulin drives K⁺ into cells faster than renal excretion, producing acute
hypokalemia; peaked T waves paradoxically appear first because of concomitant
acidosis and plasma K⁺ redistribution—then fall dangerously.
6. Which cellular change in hepatocytes is most characteristic of chronic ethanol
ingestion?
A. Ballooning degeneration from oxidative ER stress
B. Mallory-Denk body formation due to keratin hyperphosphorylation
C. Glycogen depletion from impaired gluconeogenesis
D. Steatosis from defective VLDL assembly
Correct Answer: B
Rationale: Ethanol metabolism increases ROS and acetaldehyde, leading to keratin 8/18
phosphorylation and Mallory-Denk bodies—pathognomonic for alcoholic hepatitis.
7. A 55-year-old man with essential hypertension (BP 168/102 mmHg) has a left
ventricular mass index of 135 g/m². Which myocyte adaptation is primarily
responsible?
A. Hyperplasia regulated by IGF-1
B. Eccentric hypertrophy from volume overload
C. Concentric hypertrophy driven by pressure overload
D. Myocyte apoptosis with fibroblast proliferation
Correct Answer: C
Rationale: Chronic pressure overload increases systolic wall stress, activating PI3K/Akt
and MAPK pathways → concentric hypertrophy (thicker walls) without chamber dilation.
Learning Complete Final Examination | Actual Questions &
Verified Answers | Comprehensive Pathophysiology
Assessment | Pass Guarantee
1. A 68-year-old man with a 40-pack-year smoking history presents with progressive
dyspnea on exertion and a barrel chest. Arterial blood gas on room air shows pH
7.35, PaCO₂ 65 mmHg, HCO₃⁻ 38 mEq/L, PaO₂ 52 mmHg. Which cellular
adaptation most directly accounts for the morphologic change in his lungs?
A. Dysplasia of bronchial epithelium
B. Hyperplasia of type II pneumocytes
C. Hypertrophy of bronchial smooth muscle
D. Atrophy of alveolar septa
Correct Answer: D
Rationale: Chronic alveolar septal destruction (emphysema) removes elastic recoil,
causing terminal airway collapse on expiration and air trapping. The loss of septa
produces “barrel chest” morphology. Atrophy—not hyperplasia—of septa is the dominant
cellular change.
2. A patient with severe Crohn disease develops a deep vein thrombosis. Which
circulating mediator released from inflamed bowel mucosa most directly shifts
the hemostatic balance toward thrombosis?
A. Interleukin-6 inducing hepatic thrombopoietin
B. Tissue factor–bearing microparticles entering portal circulation
C. C-reactive protein inhibiting antithrombin III
D. Nitric oxide scavenging by superoxide
Correct Answer: B
,Rationale: Active IBD lesions shed TF⁺ microparticles that activate factor VII, initiating
systemic coagulation. IL-6 and CRP are pro-inflammatory but do not directly trigger
coagulation cascade.
3. After 3 days of persistent vomiting from pyloric stenosis, a 5-week-old infant is
admitted with serum Na⁺ 128 mEq/L, K⁺ 2.9 mEq/L, Cl⁻ 88 mEq/L, pH 7.50. Which
acid–base disorder is present?
A. Metabolic acidosis with respiratory compensation
B. Metabolic alkalosis with paradoxical aciduria
C. Respiratory alkalosis with renal compensation
D. Metabolic alkalosis with appropriate respiratory acidosis
Correct Answer: B
Rationale: Loss of gastric HCl produces metabolic alkalosis; hypochloremia and
hypokalemia stimulate distal H⁺ secretion (aciduria) despite systemic alkalosis—classic
“paradoxical aciduria.”
4. A 28-year-old woman with sickle cell trait experiences sudden dyspnea while
climbing at 4,500 m. Which pathophysiologic event in the pulmonary
microvasculature is most likely?
A. Intravascular sickling triggered by hypoxia-induced rightward shift of the O₂
dissociation curve
B. Vaso-occlusion by rigid red cells in the relatively hypoxic renal medulla with
secondary platelet activation
C. Localized sickling in subsegmental vessels because of low alveolar PO₂ and
slow capillary transit
D. Endothelial activation by high-altitude cytokine storm
Correct Answer: C
Rationale: Even trait RBCs sickle when PO₂ falls below ~40 mmHg; lung zones at
altitude achieve this, causing micro-occlusion and acute chest syndrome.
5. A patient with diabetic ketoacidosis receives an insulin bolus. Thirty minutes
later the ECG shows peaked T waves and widened QRS. Which plasma shift best
explains the cardiotoxicity?
, A. Intracellular K⁺ influx driven by insulin
B. Extracellular K⁺ shift into cells lowering plasma K⁺
C. Rapid decline in plasma osmolality causing cerebral edema
D. Phosphate entry into cells lowering plasma Ca²⁺
Correct Answer: B
Rationale: Insulin drives K⁺ into cells faster than renal excretion, producing acute
hypokalemia; peaked T waves paradoxically appear first because of concomitant
acidosis and plasma K⁺ redistribution—then fall dangerously.
6. Which cellular change in hepatocytes is most characteristic of chronic ethanol
ingestion?
A. Ballooning degeneration from oxidative ER stress
B. Mallory-Denk body formation due to keratin hyperphosphorylation
C. Glycogen depletion from impaired gluconeogenesis
D. Steatosis from defective VLDL assembly
Correct Answer: B
Rationale: Ethanol metabolism increases ROS and acetaldehyde, leading to keratin 8/18
phosphorylation and Mallory-Denk bodies—pathognomonic for alcoholic hepatitis.
7. A 55-year-old man with essential hypertension (BP 168/102 mmHg) has a left
ventricular mass index of 135 g/m². Which myocyte adaptation is primarily
responsible?
A. Hyperplasia regulated by IGF-1
B. Eccentric hypertrophy from volume overload
C. Concentric hypertrophy driven by pressure overload
D. Myocyte apoptosis with fibroblast proliferation
Correct Answer: C
Rationale: Chronic pressure overload increases systolic wall stress, activating PI3K/Akt
and MAPK pathways → concentric hypertrophy (thicker walls) without chamber dilation.
